Dr David Rubin Answers COVID-19 Vaccine Questions

From the beginning of the COVID-19 pandemic, people with inflammatory bowel disease (IBD) have had many questions. Now that vaccines against the virus are becoming available, people living with Crohn's disease or ulcerative colitis need even more information in order to make decisions. I asked Dr David Rubin, Chief of the Section of Gastroenterology, Hepatology & Nutrition and the Co-Director of the Digestive Diseases Center at The University of Chicago Medicine to answer some of these initial questions about the first COVID-19 vaccines (manufactured by Pfizer and Moderna). Topics discussed on this episode include:

• How vaccines work
• How mRNA works
• How IBD medications affect the immune system
• IBD medications and their potential effect on COVID-19 vaccination
• When we'll have more information about COVID-19 vaccines and IBD
• Why side effects with vaccines are expected and what they mean

Key Quotes:

• The first thing is to remember that inflammatory bowel disease itself is a condition where in almost all situations, the immune system is overactive. So having Crohn's disease or ulcerative colitis is not a situation where you're immune deficient.
• So IBD patients in all the analyses during COVID have not actually been found to be at increased risk for getting infected, or at increased risk for developing COVID as having just because they have Crohn's or colitis or have an ostomy or have a j pouch.
• The messenger RNA is degraded within a couple days it's out of your system doesn't hang around. It doesn't ever enter the nucleus of cells, it doesn't become a permanent part of your genetic material in your body. And therefore that's why it is thought to be extremely safe.
• But I want to make it clear to everyone that they didn't just decide to do this in February, March. This was something that actually was in development, it just got pushed through because of the critical nature of the pandemic.
• ... there are no data to say that vaccination triggers IBD. And it's been looked at carefully in many studies. And there's no data to show that getting a vaccine triggers a relapse of your IBD. And the newer vaccines that we're talking about here, will not do that either.
• ...we don't know for sure yet is whether you'll have impaired ability to mount a protective immunity at the same level as if you weren't on therapy. But that doesn't mean you won't develop any immunity. And in fact, it's possible that you'll develop the same immunities to general population because the messenger RNA vaccine is a completely new mechanism.

Dr Rubin's Tweets and Tweetorials:

• "I've created a thread that summarizes the statements from the #IOIBD global expert panel about management of #IBD during #COVID19." https://threadreaderapp.com/thread/1247526583985823749.html
• "Here are my thoughts and a few updates about #SARSCoV2 vaccines, and also about implications for our #IBD patients. A tweetorial in 20 parts." https://threadreaderapp.com/thread/1333972549848469508.html
• "Terrific @US_FDA presser this morning. The agency has its origins in SAFETY and then EFFICACY became part of their regulatory pathway. Both Director Hahn @SteveFDA and career scientist Dr. Peter Marks @FDACBER used the language "safety and efficacy" (in that order). IMPORTANT." https://twitter.com/IBDMD/status/1337771896721563655

Further Reading:

• Understanding How Vaccines Work
• How mRNA Vaccines Work
• Understanding and Explaining mRNA COVID-19 Vaccines
• How the Pfizer-BioNTech Vaccine Works (NYT: Paywall)
• GI Physicians Urge COVID-19 Vaccines for All IBD Patients
• COVID-19 Vaccines: What IBD Patients & Caregivers Need to Know
• Getting a COVID-19 Vaccine: What to Know If You're Immunocompromised
• Expect Mild Side Effects From COVID-19 Vaccines, CDC Advisory Group Says
• Doctors for America COVID Vaccine FAQ Toolkit

Scholarly Publications:

• Winter is coming! Clinical, immunological, and practical considerations for vaccinating patients with IBD during the COVID pandemic
• COVID-19 vaccinations in patients with inflammatory bowel disease
• Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial

Find David T. Rubin, MD at The University of Chicago Medicine, Twitter, Rubin Lab, Rubin's Reflections (Blog), and Cornerstones Health.

Find Amber J Tresca at AboutIBD.com, Verywell, Facebook, Twitter, Pinterest, and Instagram.

Credits: Mix and sound design is by Mac Cooney. Theme music, "IBD Dance Party," is from ©Cooney Studio.